Erschienen in:
01.01.2009 | Original
Passive leg raising for predicting fluid responsiveness: importance of the postural change
verfasst von:
Julien Jabot, Jean-Louis Teboul, Christian Richard, Xavier Monnet
Erschienen in:
Intensive Care Medicine
|
Ausgabe 1/2009
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Abstract
Objective
For predicting fluid responsiveness by passive leg raising (PLR), the lower limbs can be elevated at 45° either from the 45° semi-recumbent position (PLRSEMIREC) or from the supine position (PLRSUPINE). PLRSUPINE could have a lower hemodynamic impact than PLRSEMIREC since it should not recruit the splanchnic venous reservoir.
Setting
A 24-bed medical intensive care unit.
Patients and participants
A total of 35 patients with circulatory failure who responded to an initial PLRSEMIREC by an increase in cardiac index ≥ 10%.
Interventions
PLRSEMIREC, a transfer from the semi-recumbent to the supine position and PLRSUPINE were performed in all patients in a random order before fluid expansion (500 mL saline).
Measurements and results
PLRSEMIREC, supine transfer and PLRSUPINE significantly increased the pulse-contour derived cardiac index (PiCCOplus) by 22 (17–28)%, 9 (5–15)% and 10 (7–14)% (P < 0.05 vs. PLRSEMIREC for the latter two), respectively. These maneuvers significantly increased the right ventricular end-diastolic area (echocardiography) by 20 (14–29)%, 9 (5–16)% and 10 (5–16)% (P < 0.05 vs. PLRSEMIREC for the latter two) and the central venous pressure by 33 (22–50)%, 15 (10–20)% and 20 (15–29)% (P < 0.05 vs. PLRSEMIREC for the latter two), respectively. Volume expansion significantly increased cardiac index by 27 (21–38)% and all patients were responders to volume expansion. If an increase in cardiac index ≥ 10% is considered as a positive response to PLRSUPINE, 15 (43%) patients would have been unduly predicted as non-responders to fluid administration by PLRSUPINE.
Conclusions
PLRSEMIREC induces larger increase in cardiac preload than PLRSUPINE and may be preferred for predicting fluid responsiveness.